Aspiration Events in Patients Undergoing Cardiac Catheterization for ST-Elevation Myocardial Infarction

Background
Patients undergoing cardiac catheterization with conscious sedation are routinely placed on ‘nothing per oral’ or NPO status for at least two hours, and frequently much longer, pre-procedurally. However, the risk of aspiration with conscious sedation during cardiac catheterization has not been established, while decreased patient satisfaction and disruption of homeostasis is observed with this practice. In this study, we examined the incidence of aspiration events in a population of patients with ST-elevation myocardial infarction (STEMI), who underwent emergent cardiac catheterization in a presumed non-fasting state.

Methods
We retrospectively reviewed 587 patients admitted with STEMI who underwent emergent cardiac catheterization at University of Maryland Medical Center and at St. Joseph's Medical Center. We excluded from analysis: intubated patients, post-cardiac arrest patients, those receiving no procedural sedation, and those with pre-existing pneumonia. In the remaining cohort, we reviewed clinical documentation and radiographic imaging to assess for aspiration events and categorized patients as having ‘no aspiration,’ ‘definite aspiration’ or ‘possible aspiration.’

Results
After applying exclusion criteria, 454/587 patients were eligible for review. Zero cases of definite aspiration and four cases of possible aspiration, representing 0.9% of included cases, were identified.

Conclusions
The benefits of fasting before elective cardiac catheterization have not been demonstrated in the literature. In our patient cohort undergoing cardiac catheterization for STEMI in a presumed non-fasting state, there were no definite cases of aspiration identified. This data brings into question the benefits of routine fasting before elective catheterization. Further clinical research is warranted to guide fasting practices in cardiac catheterization.